Tongue Cancer

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Tongue cancers are malignant tumors, usually "squamous cell cancers", that can originate on any part of the tongue surface. These cancers are divided into those that arise in the oral tongue; the part of the tongue that resides within the oral cavity, and the 'base of the tongue', the part of the tongue that cannot be easily be seen during a typical oral exam.

Tongue cancer is often grouped with other mouth cancers, such as cancer of the lips, hard palate, cheek lining, floor of the mouth (portion of the mouth underneath the front of the tongue) or gums. These cancers are collectively known as oral cavity cancer.

Risk Factors

The exact cause of tongue cancer is unknown. However, the following lifestyle factors may be related:

• Smoking cigarettes, cigars or a pipe
• Poor oral and dental hygiene
• Irritation of the mucous membranes in the mouth due to smoking and drinking
• Use of chewing tobacco, snuff or other tobacco products
• Heavy alcohol consumption

Recently, human papilloma viruses (HPV), the same types that are associated with cervical cancer, have been linked to the development of tongue and tonsil squamous cell cancers. The link is very strong in patients with little or no history of smoking or alcohol abuse. The tumor biopsy can be sent for analysis to determine the presence of HPV; this is important because the presence of HPV may be associated with a much better prognosis.

Symptoms

If you have any of these symptoms do not assume it is due to tongue cancer. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

• Persistent tongue pain or ulcers
• Difficulty swallowing for a period of time
• Numbness or difficulty moving the tongue
• Change in speech (due to inability to move the tongue over the teeth when speaking)
• Pain when chewing and speaking
• Bleeding from the mouth or tongue

Diagnosis

Tongue cancer may be detected by your dentist during a routine dental cleaning, or by your doctor during a routine physical exam.

To confirm diagnosis, your doctor will ask about your symptoms and medical history, and perform a physical exam. This may include:

• Examination of your tongue for lumps or masses
• Use of a fiberoptic scope-a thin tube with a tiny camera to examine the base of the tongue
• A tongue biopsy-removal of a sample of tongue tissue to test for cancer cells
• CT scan-a type of X-ray that uses a computer to make pictures of the mouth
• Chest X-ray to determine if the cancer has spread to the lungs
• Other imaging such as MRI or PET scanning

Treatment

Treatment depends on the stage of the cancer, as well as the size and location of the tumor.

Surgery

This is surgical removal of the cancerous tumor and nearby tissue, and possibly nearby lymph nodes. This is often the preferred treatment when the tumor is on the visible side of the tongue, when it is quite small (less than 2 cm), and when it is lateralized to one side and does not involve the base of the tongue.

Radiation Therapy (or Radiotherapy)

This is the use of radiation to kill cancer cells and shrink tumors. This method is used when the cancer is at the back of the tongue.

Chemotherapy

Chemotherapy is sometimes used with radiation to destroy the cancerous growth, especially if surgery is not planned.

Rehabilitation and Follow-Up

After treatment, your doctor may recommend:

• Therapy to improve tongue movement, chewing, and swallowing
• Speech therapy, if use of the tongue is affected
• Close monitoring of your mouth, throat, esophagus and lungs to see if the cancer has come back or spread

Prevention

To help reduce your chance of getting tongue cancer, take the following steps:

• Don't smoke or use tobacco products. If you do smoke or use tobacco products, get help to quit.
• Avoid heavy alcohol consumption.
• See your doctor regularly for check-ups and cancer screening exams.